The Kroger Co

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

8630 Issued in GA

Legal business name

THE KROGER CO

Practice address

2655 Freedom Pkwy
Cumming, GA 30041-9177

Phone

(770) 781-6689

Fax

(770) 781-6694

NPI assigned

Jul 13, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Allison Muennich

Title

Manager of Pharmacy Licensing

Phone

(513) 762-1019

Specialties & licenses 3

Addresses

Other identifiers 2

Other names 1

• KROGER PHARMACY Doing business as

Medicare fee-for-service enrollment

Enrolled in GA2 enrollments

Enrollment records 2

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Medicare medical equipment & supply locations

Tax ID family

Kroger Sav on J926319 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

• The Kroger Co

  • Community/Retail Pharmacy
  • Gainesville, GA
  • NPI 1669893491
  NPD tax ID
• The Kroger Co

  • Community/Retail Pharmacy
  • Decatur, GA
  • NPI 1679507404
  NPD tax ID
• The Kroger Co

  • Community/Retail Pharmacy
  • Covington, GA
  • NPI 1689608408
  NPD tax ID
• The Kroger Co

  • Community/Retail Pharmacy
  • Atlanta, GA
  • NPI 1689699464
  NPD tax ID
• The Kroger Co

  • Community/Retail Pharmacy
  • Cumming, GA
  • NPI 1699272765
  NPD tax ID
• The Kroger Co

  • Community/Retail Pharmacy
  • Dallas, GA
  • NPI 1699709402
  NPD tax ID
• The Kroger Co

  • Community/Retail Pharmacy
  • Warner Robins, GA
  • NPI 1699709410
  NPD tax ID
• The Kroger Co

  • Community/Retail Pharmacy
  • Canton, GA
  • NPI 1700810512
  NPD tax ID
• The Kroger Co

  • Community/Retail Pharmacy
  • Newnan, GA
  • NPI 1710040225
  NPD tax ID
• The Kroger Co

  • Community/Retail Pharmacy
  • Grovetown, GA
  • NPI 1710335443
  NPD tax ID
• The Kroger Co

  • Community/Retail Pharmacy
  • Woodstock, GA
  • NPI 1720012560
  NPD tax ID
• The Kroger Co

  • Community/Retail Pharmacy
  • Duluth, GA
  • NPI 1720012610
  NPD tax ID

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Lisa Sanders, RPH

  • Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
  • Cumming, GA
  • NPI 1417587940
  NPD (past)
• Olivia Stoner Sikes, RPH035081

  • Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
  • Cumming, GA
  • NPI 1699509364
  NPD (past)
• Xin Wang, PHARMD

  • Pharmacist
  • Cumming, GA
  • NPI 1982203907
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152748800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1463356800000",
    "number": "1730104514",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 842772",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "022842772",
            "telephone_number": "513-762-1019",
            "fax_number": "513-762-1092"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2655 FREEDOM PKWY",
            "city": "CUMMING",
            "state": "GA",
            "postal_code": "300419177",
            "telephone_number": "770-781-6689",
            "fax_number": "770-781-6694"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE KROGER CO",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-13",
        "last_updated": "2016-05-16",
        "status": "A",
        "authorized_official_last_name": "MUENNICH",
        "authorized_official_first_name": "ALLISON",
        "authorized_official_title_or_position": "MANAGER OF PHARMACY LICENSING",
        "authorized_official_telephone_number": "513-762-1019"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "GA",
            "license": "8630",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00839583B",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2014608",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "KROGER PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• All providers in Cumming, GA
• Community/Retail Pharmacy in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.